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The explosion in knowledge of cancer genetics during the past decade has led to the availability of abundant information about the incidence of cancer-causing mutations, disease penetrance, and risk-reduction strategies. The application of this information to clinical practice is enormously challenging because of the lack of prospective, randomized trials and the inherent individual variability of preferences regarding ways of reducing risk. The attitudes of patients toward genetic testing for mutations that cause cancer add to the complexity of decisions about the appropriate use of the results of such tests by physicians. Until we find acceptable alternatives to prophylactic surgery, ignorance
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